Fundamental Medical Mycology

Errol Reiss, Ph.D., is Adjunct Professor of Microbiology at Emory University School of Medicine (EUSM), Atlanta, Georgia, and Research Microbiologist, Molecular Typing Unit, Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases in the Centers for Disease Control and Prevention, Atlanta, Georgia. Department of Microbiology and Immunology. Dr. Reiss previously published a single-author textbook in the field of medical mycology (see below) and has published several book chapters, review articiles and a total of? 87 primary research literature publications. H. Jean Shadomy, Ph.D., is Adjunct Professor of Dermatology, EUSM, Atlanta. A career microbiologist, she has several book chapters and more than 40 published primary literature articles to her name.

Preface xvii Acknowledgments xix Part One Introduction to Fundamental Medical Mycology, Laboratory Diagnostic Methods, and Antifungal Therapy 1. Introduction to Fundamental Medical Mycology 3 1.1 Topics not Covered, or Receiving Secondary Emphasis 3 1.2 Biosafety Considerations: Before You Begin Work with Pathogenic Fungi... 3 1.3 Fungi Defined: Their Ecologic Niche 5 1.4 Medical Mycology 5 1.5 A Brief History of Medical Mycology 6 1.6 Rationale for Fungal Identification 9 1.7 Sporulation 11 1.8 Dimorphism 11 1.9 Sex in Fungi 13 1.10 Classification of Mycoses Based on the Primary Site of Pathology 13 1.11 Taxonomy/Classification: Kingdom Fungi 14 1.12 General Composition of the Fungal Cell 21 1.13 Primary Pathogens 25 1.14 Endemic Versus Worldwide Presence 26 1.15 Opportunistic Fungal Pathogens 26 1.16 Determinants of Pathogenicity 27 2. Laboratory Diagnostic Methods in Medical Mycology 31 2.1 Who Is Responsible for Identifying Pathogenic Fungi? 31 2.2 What Methods are Used to Identify Pathogenic Fungi? 31 2.3 Laboratory Detection, Recovery, and Identification of Fungi in the Clinical Microbiology Laboratory 33 2.4 Genetic Identification of Fungi 64 3A. Antifungal Agents and Therapy 75 3B. Antifungal Susceptibility Tests 107 Part Two Systemic Mycoses Caused by Dimorphic Environmental Molds (Endemic Mycoses) 4. Blastomycosis 125 4.1 Blastomycosis-at-a-Glance 125 4.2 Introduction/Disease Definition 125 4.3 Case Presentations 126 4.4 Diagnosis 127 4.5 Etiologic Agent 127 4.6 Geographic Distribution/Ecologic Niche 128 4.7 Epidemiology 129 4.8 Risk Groups/Factors 129 4.9 Transmission 129 4.10 Determinants of Pathogenicity 130 4.11 Clinical Forms 131 4.12 Veterinary Forms 133 4.13 Therapy 133 4.14 Laboratory Detection, Recovery, and Identification 134 5. Coccidioidomycosis 141 5.1 Coccidioidomycosis-at-a-Glance 141 5.2 Introduction/Disease Definition 141 5.3 Case Presentations 142 5.4 Diagnosis 143 5.5 Etiologic Agents 143 5.6 Geographic Distribution / Ecologic Niche 144 5.7 Epidemiology 147 5.7.1 Incidence and Prevalence 147 5.8 Risk Groups / Factors 149 5.9 Transmission 150 5.10 Determinants of Pathogenicity and Pathogenesis 151 5.11 Clinical Forms 155 5.12 Veterinary Forms 156 5.13 Therapy 156 5.14 Laboratory Detection, Recovery, and Identification 158 6. Histoplasmosis 165 6.1 Histoplasmosis-at-a-Glance 165 6.2 Introduction / Disease Definition 165 6.3 Case Presentations 166 6.4 Etiologic Agents 169 6.5 Geographic Distribution/Ecologic Niche 170 6.6 Epidemiology 171 6.7 Transmission 171 6.8 Determinants of Pathogenicity 172 6.9 Clinical Forms 175 6.10 Veterinary Forms 178 6.11 Therapy 179 6.12 Laboratory Detection, Recovery, and 7. Paracoccidioidomycosis 187 7.1 Paracoccidioidomycosis-ata-Glance 187 7.2 Introduction/Disease Definition 187 7.3 Case Presentation 188 7.4 Etiologic Agent 188 7.5 Geographic Distribution/Ecologic Niche 189 7.6 Epidemiology 189 7.7 Transmission 191 7.8 Determinants of Pathogenicity 191 7.9 Clinical Forms 192 7.10 Veterinary Forms 193 7.11 Therapy 194 7.12 Laboratory Detection, Recovery, and Identification 195 8. Penicilliosis 201 8.1 Penicilliosis-at-a-Glance 201 8.2 Introduction/Disease Definition 201 8.3 Case Presentation 202 8.4 Diagnosis 203 8.5 Etiologic Agents 203 8.6 Geographic Distribution / Ecologic Niche 203 8.7 Epidemiology 204 8.8 Risk Groups/Factors 205 8.9 Transmission 205 8.10 Determinants of Pathogenicity 205 8.11 Clinical Forms 206 8.12 Veterinary Forms 208 8.13 Therapy 208 8.14 Laboratory Detection, Recovery, and Identification 208 9. Sporotrichosis 215 9.1 Sporotrichosis-at-a-Glance 215 9.2 Introduction/Disease Definition 215 9.3 Case Presentations 216 9.4 Diagnosis 218 9.5 Etiologic Agents 218 9.6 Geographic Distribution/Ecologic Niche 219 9.7 Epidemiology 219 9.8 Transmission 220 9.9 Determinants of Pathogenicity 220 9.10 Clinical Forms 223 9.11 Human-Animal Interface 224 9.12 Therapy 225 9.13 Laboratory Detection, Recovery, and Identification 227 10A. Less Frequent Mycoses Caused by Dimorphic Environmental Molds: Adiaspiromycosis 233 10B. Less Frequent Mycoses Caused by Dimorphic Environmental Molds (Endemic Mycoses): Lobomycosis (Jorge Lobo's Disease) 241 Part Three Systemic Mycoses Caused by Opportunistic Yeasts and Pneumocystis 11. Candidiasis and Less Common Yeast Genera 251 11.1 Candidiasis-at-a-Glance 251 11.2 Introduction/Disease Definition 251 11.3 Case Presentations 252 11.4 Diagnosis 255 11.5 Etiologic Agents and their Ecologic Niches 255 11.6 Epidemiology 258 11.7 Risk Groups/Factors 264 11.8 Transmission 265 11.9 Clinical Forms 266 11.10 Determinants of Pathogenicity 273 11.11 Therapy 282 11.12 Laboratory Detection, Recovery, and Identification 286 11.13 Less Common Opportunistic Yeast Genera 292 12. Cryptococcosis 303 12.1 Cryptococcosis-at-a-Glance 303 12.2 Introduction/Disease Definition 303 12.3 Case Presentations 304 12.4 Etiologic Agents 307 12.5 Geographic Distribution/Ecologic Niche 311 12.6 Epidemiology 312 12.7 Risk Groups/Factors 315 12.8 Transmission 316 12.9 Determinants of Pathogenicity 316 12.10 Clinical Forms 321 12.11 Veterinary Forms 323 12.12 Therapy 324 12.13 Laboratory Detection, Recovery, and Identification 326 13. Pneumocystosis 333 13.1 Pneumocystosis-at-a-Glance 333 13.2 Introduction/Disease Definition 333 13.3 Case Presentation 334 13.4 Etiologic Agent 335 13.5 Geographic Distribution/Ecologic Niche 336 13.6 Epidemiology 337 13.7 Risk Groups/Factors 339 13.8 Transmission 340 13.9 Determinants of Pathogenicity 340 13.10 Clinical Forms 343 13.11 Therapy 346 13.12 Laboratory Detection, Recovery, and Identification 348 Part Four Systemic Mycoses Caused by Opportunistic Hyaline Molds 14. Aspergillosis 357 14.1 Aspergillosis at-a-Glance 357 14.2 Introduction/Disease Definition 358 14.3 Case Presentations 358 14.4 Etiologic Agents 361 14.5 Geographic Distribution/Ecologic Niche 362 14.6 Epidemiology and Risk Groups/Factors 363 14.7 Transmission 369 14.8 Determinants of Pathogenicity 370 14.9 Clinical Forms 375 14.10 Veterinary Forms 378 14.11 Therapy 379 14.12 Laboratory Detection, Recovery, and Identification 383 15. Fusarium Mycosis 397 15.1 Fusarium Mycosis-at-a-Glance 397 15.2 Introduction/Disease Definition 398 15.3 Case Presentation 398 15.4 Etiologic Agents 399 15.5 Geographic Distribution/Ecologic Niche 399 15.6 Epidemiology 399 15.7 Transmission 401 15.8 Determinants of Pathogenicity 401 15.9 Clinical Forms 402 15.10 Veterinary Forms 404 15.11 Therapy 405 15.12 Laboratory Detection, Recovery, and Identification 407 16. Pseudallescheria/Scedosporium Mycosis 413 16.1 Pseudallescheria/Scedosporium Mycosis-at-a-Glance 413 16.2 Introduction/Disease Definition 414 16.3 Case Presentations 414 16.4 Diagnosis 416 16.5 Etiologic Agents 416 16.6 Geographic Distribution/Ecologic Niche 418 16.7 Epidemiology 419 16.8 Transmission 421 16.9 Determinants of Pathogenicity 421 16.10 Clinical Forms 422 16.11 Veterinary Forms 423 16.12 Therapy 424 16.13 Laboratory Detection, Recovery, and Identification 426 17A. Mucormycosis 431 17B. Entomophthoramycosis Caused by Basidiobolus ranarum 457 17C. Entomophthoramycosis Caused by Conidiobolus Species 467 Part Five Mycoses of Implantation 18. Chromoblastomycosis 479 18.1 Chromoblastomycosis-at-a-Glance 479 18.2 Introduction/Disease Definition 479 18.3 Case Presentation 480 18.4 Diagnosis 480 18.5 Etiologic Agents 481 18.6 Geographic Distribution/Ecologic Niche 482 18.7 Epidemiology and Risk Groups/Factors 482 18.8 Transmission 483 18.9 Determinants of Pathogenicity 483 18.10 Clinical Forms 485 18.11 Therapy 485 18.12 Laboratory Detection, Recovery, and Identification 487 19. Phaeohyphomycosis 493 19.1 Phaeohyphomycosis-at-a-Glance 493 19.2 Introduction 493 19A Cutaneous-Subcutaneous Phaeohyphomycosis 494 19B Cerebral Phaeohyphomycosis 499 19C Fungal Sinusitis 503 19.3 Laboratory Detection, Recovery, and Identification 506 20. Eumycetoma (Madura Foot, Maduramycosis) 513 20.1 Eumycetoma at-a-Glance 513 20.2 Introduction/Disease Definition 513 20.3 Case Presentation 514 20.4 Diagnosis 514 20.5 Etiologic Agent(s) 514 20.6 Geographic Distribution/Ecologic Niche 515 20.7 Epidemiology 515 20.8 Risk Groups/Factors 516 20.9 Transmission 516 20.10 Determinants of Pathogenicity 516 20.11 Clinical Forms (Fahal, 2004) 517 20.12 Veterinary Forms 518 20.13 Therapy 518 20.14 Laboratory Detection, Recovery, and Identification 520 Part Six Dermatophytosis and Dermatomycoses (Superficial Cutaneous Mycoses) 21. Dermatophytosis 527 21.1 Dermatophytosis-at-a-Glance 527 21.2 Introduction/Disease Definition 528 21.3 Case Presentations 529 21.4 Diagnosis 530 21.5 Etiologic Agents 530 21.6 Geographic Distribution/Ecologic Niche 534 21.7 Epidemiology 534 21.8 Risk Groups/Factors 537 21.9 Transmission 539 21.10 Determinants of Pathogenicity 540 21.11 Clinical Forms 542 21.12 Veterinary Forms 550 21.13 Therapy 552 21.14 Laboratory Detection, Recovery, and Identification 554 22. Dermatomycoses 567 22A Major Nondermatophytic Fungi from Skin and Nails 567 22B Superficial Mycosis of the Hair Caused by a Nondermatophyte Mold: Black Piedra 569 22C Superficial Mycoses Caused by Yeasts and Yeast-like Fungi 571 22D Chrysosporium and Other Nonpathogenic or Opportunistic Fungi Isolated from Skin and Resembling Dermatophytes in Culture 584 Selected References for Dermatomycoses 585 Website Cited 587 Questions 587 Glossary 589 Answer Key 607 Index 611